Background: Achievable benchmarks of care (ABCs) can reduce unnecessary testing and treatment as well as curb hospital costs and set performance standards amongst hospitals nationwide. We examined changes in performance gaps and achievable benchmarks of care in children hospitalized with bronchiolitis throughout the pre-, early, late and now post-pandemic timeframes.
Methods: This retrospective cohort study used data from the Pediatric Health Information System (PHIS) database to examine inpatient or observation encounters between September 2018–March 2025 for children aged 28 days to 2 years with a principal discharge diagnosis of bronchiolitis (J 21.X). We examined usage, ABCs, and performance gaps in viral testing, chest x-rays (CXR), and complete blood counts (CBCs) as well as treatment with bronchodilators, steroids, and antibiotics.
Results: There were 170,765 patients that met inclusion criteria. Usage of viral testing has exploded from pre-pandemic to now (39.9% to 67.6%); it is also the modality where the least amount of hospitals meet benchmark. CBC usage has been relatively stable with regards to benchmark, variation, and performance gaps. CXR usage had some mild fluctuation but remains close to pre-pandemic usage levels (27.9%). For CXR usage, most hospitals were able to stay within 20 percentage points of benchmark performance during all timeframes. By comparison, only 16 out of 39 hospitals were able to perform within 20 percentage points of the benchmark during 3-4 time periods for bronchodilators. Overall steroid usage has increased and this change has been sustained post pandemic (10% vs 14.1%). Antibiotic usage had a statistically significant decrease in the early pandemic and this has been sustained post pandemic (27.2%). All 39 hospitals were performing within benchmark for antibiotics pre-pandemic. Not taking into account viral testing, there were 6 hospitals that performed within 20 percentage points of the benchmark during all timeframes and all measures.
Conclusions: Covid-19 emerged in 2020 and is here to stay as an important cause of bronchiolitis. Bronchodilator usage remains the area with the largest performance gaps and could benefit the most from focused quality improvement efforts. Future studies could focus on the highest performing hospitals to learn if processes and pathways were in place to allow consistent standards of excellence, even during the pandemic and largest recent health crises in the United States.
